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October 13, 1978

Venous Air Embolism and Lumbar Disk Surgery

JAMA. 1978;240(16):1713. doi:10.1001/jama.1978.03290160031005

To the Editor.—  Concerning venous air embolism and the use of right atrial catheters in lumbar disk surgery as noted in recent letters and questions (238:253,1977; 239:496,1978; and 240:110, 1978), I would like to emphasize again that the critical precipitating factor relates to the negative gradient that exists between the right side of the heart and the incised capacitance vessel. Naturally, the large gradient found in the sitting position would tend to enhance greatly the entrance of air from an open venous channel, as likewise would the use of a negatively phased ventilator or a position favoring a negative caval pressure (as can occur with the Hastings frame).1It really does not matter what operative procedures are performed, whether they be head and neck surgery, gynecologic procedures in lithotomy, general surgery in steep Trendelenburg, or intracranial surgery in the supine, lateral, or prone position with the head elevated above